INTERNAL MEDICINE RESIDENTS KNOWLEDGE AND MANAGEMENT OF HEPATITIS C VIRUS (HCV) INFECTION IMPROVE WITH A TARGETED EDUCATIONAL INTERVENTION.
B. Pearlman, Center for Hepatitis C, Atlanta, GA, A. Ravi, Atlanta Medical center, Atlanta, GA, C. Ehleben, Atlanta Medical Center, Atlanta, GA
Despite the enormous current and projected burden of HCV-related illness, primary care physicians knowledge about testing and management of this clinical entity is inadequate. We examined the results of a targeted yet comprehensive intervention dministered to internal medicine residents aimed at improving their facility with the diagnosis and treatment of HCV.
Internal medicine residents in three post-graduate years of training in a community-based teaching program participated in our study. The educational intervention consisted of several hours of HCV-related formal didactic lecture, handouts and self-evaluation questionnaires covering the natural history, epidemiology, screening, diagnosis, prevention and treatment of HCV over a ten-month period. Residents were also exposed to a primary care continuity clinic with many chronically infected HCV outpatients, both treatment-naïve and on interferon-based combination therapy. Ten pages of questionnaires evaluating knowledge in the aforementioned areas were administered pre- and post-intervention. Comparative data were analyzed using students t-test and ANOVA (analysis of variance).
Resident participants were equally distributed among three post-graduate years of training. A total of 29 residents participated in the intervention and pre-intervention testing, and 28 residents completed the post-intervention questionnaire. Results were partitioned into three groups including A: HCV natural history, epidemiology, screening, diagnosis, and prevention, B: HCV treatment and side-effect management and C: HCV comprehensive, which included both A and B. The mean percentage of correctly answered questions at baseline was 13.14%; however, post-intervention, the overall improvement in mean test scores was 66.1%. Residents knowledge significantly improved in all areas tested (A, p=0.00004; B, p<0.0000001; C, p<0.0000001). Knowledge differed significantly by post-graduate level of training before the intervention (A, p=0.005; B, p=0.003; C, p= 0.001), but not after the intervention (A, p=0.78; B, p=0.12; C, p=0.19), even when treatment experience was held constant. This disparity further supports the effectiveness of the teaching intervention.
We confirmed that hepatitis C knowledge is inadequate among internal medicine physicians in training. A comprehensive educational intervention administered to internal medicine residents over a ten month period was successful in improving physicians knowledge in all HCV-related areas tested. Similar educational interventions should be studied in more diverse primary care training settings.
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